It is a truth universally acknowledged that every fellow needs to find a job prior to graduation.
As is the case with each proceeding crossroad (medical school, residency, fellowship) thus far in my journey through medicine, I learn more about the process — and about my own needs and wants — the more I interview. In one particular instance in which I was inquiring about compensation models and future earning potential, I was met with the response that “money is not the best reason for choosing a position.”
To be clear, it’s not my first time hearing this statement. But these words didn’t come from the well intentions of my mother, a close friend, or a mentor who knew me well; rather, this admonition came from a faculty member actively trying to recruit me to their practice. My initial reaction of astonishment was quickly replaced by a whirlwind of disparate emotions that came as a surprise even to myself — outrage, embarrassment, fear.
I find that statement unsettling for two main reasons.
First, I took that comment personally because it seemed quite at odds with my own self-perception. I don’t consider myself to be a materialistic person — I live paycheck to paycheck, with half of my outdoor gear and apparel being either gifted or thrifted, and still drive my dad’s old 2004 Toyota with over 250,000 miles. Nor am I overly self-conscious about money — I can hardly hold a conversation about the stock market, don’t know the latest FIRE trend, and can’t even recount the meager savings in my Roth IRA. To me, money has always been a means of securing stability and flexibility in an otherwise chaotic, ever-changing world. In terms of importance with respect to job searching, money is not my first, second, third, or fourth consideration that comes to mind. Thus, to pass judgment presuming my relationship with money seems misguided at best and unempathetic at worst.
The second reason that comment grates me is that it belies a historical trend (not just in academic medicine) in which discussion and inquiries into job compensation were seen as taboo. While some might reflect on the days in which contracts were signed and affirmed with a handshake between two men with fondness, history tells us that lack of information on salary and compensation was simply another stain on the inequity facing women and underrepresented minority groups in medicine. In today’s day and age, lack of transparency in workplace compensation remains one of the chief causes behind the high job turnover rate in young faculty. In my conversations with peers around the country in a variety of medical and surgical specialties, nearly no one has received any formal education on concepts such as billing, coding, RVUs, and starting or maintaining a practice — things that many seasoned physicians find are integral to their daily workflow. If those things are so important yet untaught before so many of us leave our training, how can we begin to ascribe personal value to these seemingly abstract concepts that we have hardly any a priori knowledge about?
In going back to the initial question — should money be the most important factor in deciding a job? For me, the answer is no.
But if you, the reader, happen to decide money is of paramount importance in terms of job selection, should you feel guilty and ashamed?
I would argue, absolutely not! A 2023 study examining the impact of income and emotional well-being demonstrated a positive correlation between the two, with the relationship even more linearly pronounced for the “happiest” 30% of the study group. I don’t know your lived experience, but I do know that your journey through medicine has not come without great personal and monetary cost. I am not privy to the amount of debt you have accumulated or other life experiences that have affected how you envision and prioritize your future. At the end of the day — your motivations in securing a fulfilling job and a rewarding career can only be determined solely by YOU and no one else. Because let’s face it — to hear another platitude about how we, the collective tail-end representatives of a millennial generation searching for our first attending job, should or should not ascribe the importance of money from folks with 20 years of attending experience with a 6,000-square-foot home, 15 grandkids, and a basement golf simulator not only feels unrelatable and out of touch, but also reeks of privilege.
To my colleagues and peers either currently embroiled or just about to embark on their job searches, I give you my sincere congratulations and exhort you to consider your worth. Seek advice from mentors who know you well and are invested in your success; don’t be afraid to ask the seemingly austere and obscure questions about salary and compensation structures; share your honest thoughts and feelings with other peers who may be just as bewildered as you and me — knowing full well that the very reason academic institutions and hospital corporations are looking to hire you is a monetary matter.
And if you’re sitting on the other side doing the hiring, I implore you to be patient with us, be transparent, and indulge our questions as a way of educating and preparing the next generation of physicians, scientists, instructors, and leaders. Perception of compensation fairness and transparency not only helps in reducing inequity in medicine at the group level, but also augments individual trust in the organization, leading to higher physician satisfaction and retention. In doing so, you just might find the person who won’t abscond after two years, but will turn that job into a homestead caring for and nurturing patients and physicians for generations to come.
What has been your experience with discussing compensation? Share in the comments.
Image by Ron and Joe / Shutterstock
